Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Mini-Review

Bewegungstherapie und körperliche Aktivität bei Patienten mit Herzinsuffizienz

Published Online:August 22, 2018https://doi.org/10.1024/1661-8157/a003050

Abstract

Zusammenfassung. Herzinsuffizienz ist ein klinisches Syndrom mit unterschiedlichen Ätiologien und Phänotypen. Die überwachte Bewegungstherapie und individuelle körperliche Aktivität ist bei allen Formen eine Klasse-IA-Empfehlung in aktuellen Leitlinien. Eine Bewegungstherapie kann unmittelbar nach Stabilisierung einer akuten Herzinsuffizienz im Spital begonnen werden (Phase I). Sie kann nach Entlassung in einem stationären oder ambulanten Präventions- und Rehabilitationsprogramm fortgesetzt werden (Phase II). Typische Elemente sind Ausdauer-, Kraft- und Atemtraining. Die Kosten werden von der Krankenversicherung für drei bis sechs Monate übernommen. In erfahrenen Zentren können auch Patienten mit implantierten Defibrillatoren oder linksventrikulären Unterstützungssystemen trainieren. Wichtiges Ziel der Phase II ist neben muskulärer Rekonditionierung auch die Steigerung der Gesundheitskompetenz, um die Langzeit-Adhärenz bezüglich körperlicher Aktivität zu verbessern. In Phase III bieten Herzgruppen Unterstützung.


Exercise Training and Physical Activity in Patients with Heart Failure

Abstract. Heart failure is a clinical syndrome with different etiologies and phenotypes. For all forms, supervised exercise training and individual physical activity are class IA recommendations in current guidelines. Exercise training can start in the hospital, immediately after stabilization of acute heart failure (phase I). After discharge, it can continue in a stationary or ambulatory prevention and rehabilitation program (phase II). Typical components are endurance, resistance and respiratory training. Health insurances cover costs for three to six months. Patients with implantable cardioverter defibrillators or left ventricular assist devices may train in experienced centers. Besides muscular reconditioning, a major goal of phase II is to increase health literacy to improve long-term adherence to physical activity. In phase III, heart groups offer support.


Résumé. L’insuffisance cardiaque est un syndrome clinique ayant différentes étiologies et phénotypes. Pour toutes les formes, selon les recommandations actuelles, l’entraînement physique supervisé et l’activité physique au niveau individuel font partie de la classe IA des recommandations. L’entraînement physique peut commencer à l’hôpital, immédiatement après stabilisation de l’insuffisance cardiaque aiguë (phase I). Après la sortie de l’hôpital, il peut se poursuivre d’une manière préventive ou dans un programme de réhabilitation (phase II), soit en milieu stationnaire ou en ambulatoire. Les composants typiques sont l’endurance, la résistance et l’entraînement respiratoire. Les assurances-maladie couvrent les frais pendant trois à six mois. Les patients ayant un défibrillateur-cardioverteur implantable ou un dispositif d’assistance ventriculaire peuvent s’entraîner dans des centres expérimentés. En plus d’un reconditionnement musculaire, un but majeur de la phase II est d’augmenter les compétences sur le plan de la santé afin d’améliorer le suivi à long-terme de l’activité physique. Dans la troisième phase, des groupes de malades cardiaques sont utiles. Mots-clés: insuffisance cardiaque à fonction ventriculaire conservée, insuffisance cardiaque à insuffisance ventriculaire réduite, entraînement à l’endurance, entraînement à la résistance, entraînement à intervalles de haute intensité

Bibliografie

  • Lesyuk W, Kriza C, Kolominsky-Rabas P: Cost-of-illness studies in heart failure: a systematic review 2004–2016. BMC Cardiovasc Disord 2018; 18: 74. First citation in articleCrossref Medline, Google Scholar

  • Ponikowski P, Voors AA, Anker SD, et al.: 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37: 2129–2200. First citation in articleMedline, Google Scholar

  • Owan TE, Hodge DO, Herges RM, et al.: Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 2006; 355: 251–259. First citation in articleCrossref Medline, Google Scholar

  • Redfield MM: Heart Failure with Preserved Ejection Fraction. N Engl J Med 2016; 375: 1868–1877. First citation in articleCrossref Medline, Google Scholar

  • Paulus WJ, Tschope C: A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol 2013; 62: 263–271. First citation in articleCrossref Medline, Google Scholar

  • Coats AJ: The “muscle hypothesis” of chronic heart failure. J Mol Cell Cardiol 1996; 28: 2255–2262. First citation in articleCrossref Medline, Google Scholar

  • Coats AJ, Adamopoulos S, Meyer TE, et al.: Effects of physical training in chronic heart failure. Lancet 1990; 335: 63–66. First citation in articleCrossref Medline, Google Scholar

  • Piepoli MF, Davos C, Francis DP, et al.: Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ 2004; 328: 189. First citation in articleCrossref Medline, Google Scholar

  • O’Connor CM, Whellan DJ, Lee KL, et al.: Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 2009; 301: 1439–1450. First citation in articleCrossref Medline, Google Scholar

  • Fleg JL, Cooper LS, Borlaug BA, et al.: Exercise training as therapy for heart failure: current status and future directions. Circ Heart Fail 2015; 8: 209–220. First citation in articleCrossref Medline, Google Scholar

  • Belardinelli R, Georgiou D, Cianci G, et al.: 10-year exercise training in chronic heart failure: a randomized controlled trial. J Am Coll Cardiol 2012; 60: 1521–1528. First citation in articleCrossref Medline, Google Scholar

  • Sagar VA, Davies EJ, Briscoe S, et al.: Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. Open Heart 2015; 2: e000163. First citation in articleCrossref Medline, Google Scholar

  • Pandey A, Parashar A, Kumbhani D, et al.: Exercise training in patients with heart failure and preserved ejection fraction: meta-analysis of randomized control trials. Circ Heart Fail 2015; 8: 33–40. First citation in articleCrossref Medline, Google Scholar

  • Corra U, Agostoni PG, Anker SD, et al.: Role of cardiopulmonary exercise testing in clinical stratification in heart failure. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2018; 20: 3–15. First citation in articleCrossref Medline, Google Scholar

  • Piepoli MF, Conraads V, Corra U, et al.: Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail 2011; 13: 347–357. First citation in articleCrossref Medline, Google Scholar

  • Garber CE, Blissmer B, Deschenes MR, et al.: American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 2011; 43: 1334–1359. First citation in articleCrossref Medline, Google Scholar

  • Mezzani A, Hamm LF, Jones AM, et al.: Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation. Eur J Prev Cardiol 2013; 20: 442–467. First citation in articleMedline, Google Scholar

  • Piepoli MF, Hoes AW, Agewall S, et al.: 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37: 2315–2381. First citation in articleMedline, Google Scholar

  • Wisloff U, Stoylen A, Loennechen JP, et al.: Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation 2007; 115: 3086–3094. First citation in articleCrossref Medline, Google Scholar

  • Ellingsen O, Halle M, Conraads V, et al.: High-intensity interval training in patients with heart failure with reduced ejection fraction. Circulation 2017; 135: 839–849. First citation in articleCrossref Medline, Google Scholar

  • Meyer P, Gayda M, Juneau M, et al.: High-intensity aerobic interval exercise in chronic heart failure. Curr Heart Fail Rep 2013; 10: 130–138. First citation in articleCrossref Medline, Google Scholar

  • Meyer P, Normandin E, Gayda M, et al.: High-intensity interval exercise in chronic heart failure: protocol optimization. J Card Fail 2012; 18: 126–133. First citation in articleCrossref Medline, Google Scholar

  • Rognmo O, Moholdt T, Bakken H, et al.: Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients. Circulation 2012; 126: 1436–1440. First citation in articleCrossref Medline, Google Scholar

  • Piccini JP, Hellkamp AS, Whellan DJ, et al.: Exercise training and implantable cardioverter-defibrillator shocks in patients with heart failure: results from HF-ACTION (Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing). JACC Heart Fail 2013; 1: 142–148. First citation in articleCrossref Medline, Google Scholar

  • Ben Gal T, Piepoli MF, Corra U, et al.: Exercise programs for LVAD supported patients: A snapshot from the ESC affiliated countries. Int J Cardiol 2015; 201: 215–219. First citation in articleCrossref Medline, Google Scholar

  • Kerrigan DJ, Williams CT, Ehrman JK, et al.: Cardiac rehabilitation improves functional capacity and patient-reported health status in patients with continuous-flow left ventricular assist devices: the Rehab-VAD randomized controlled trial. JACC Heart Fail 2014; 2: 653–659. First citation in articleCrossref Medline, Google Scholar

  • Kessler C, Mahler F: Neue «Nationale Strategie» schliesst wichtige Lücke. SAEZ 2016; 97: 1518–1519. First citation in articleGoogle Scholar

  • Park LG, Schopfer DW, Zhang N, et al.: Participation in cardiac rehabilitation among patients with heart failure. J Card Fail 2017; 23: 427–431. First citation in articleCrossref Medline, Google Scholar

  • Rengo JL, Savage PD, Barrett T, et al.: Cardiac rehabilitation participation rates and outcomes for patients with heart failure. J Cardiopulm Rehabil Prev 2018; 38: 38–42. First citation in articleMedline, Google Scholar

  • Peters AE, Keeley EC: Trends and predictors of participation in cardiac rehabilitation following acute myocardial infarction: data from the Behavioral Risk Factor Surveillance System. J Am Heart Assoc 2017; 7: pii: e007664. First citation in articleMedline, Google Scholar